Provider Demographics
NPI:1992020044
Name:NORTHWEST CENTER FOR CHANGE
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:425-827-2401
Mailing Address - Street 1:10512 NE 68TH ST.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-827-2401
Mailing Address - Fax:
Practice Address - Street 1:10512 NE 68TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7002
Practice Address - Country:US
Practice Address - Phone:425-827-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17149600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health